A bladder cancer patient is confronted with a totally new vocabulary and set of definitions that might as well be a foreign language.  Some of the most confusing and yet salient terms refer to the grade and stage of the tumors mentioned in the pathology report.

Non Invasive

Non-muscle invasive bladder cancer is sometimes referred to as “superficial bladder cancer” because the cancer cells are contained in the bladder lining and have not invaded the muscle or the deeper layers of the bladder. Superficial does NOT mean this should not be taken seriously.

Carcinoma in Situ

“Carcinoma in situ” is a general term that refers to a cancer that is still confined to the cells in which it initially started and has not spread into any nearby tissue. In some tissues, breast for example, it is not considered a cause for much concern. THIS IS NOT THE CASE FOR BLADDER CANCER. Bladder carcinoma in situ (abbreviated “CIS”) is always high grade and requires immediate treatment.

Muscle Invasive

Muscle invasive bladder cancer, sometimes simply referred to as “invasive bladder cancer”, occurs when cancer cells have gone through the bladder lining and are present in the muscle. This bladder cancer type poses the possibility of the spread of the cancer into additional areas of the body and, therefore, treatment is essential.


If the cancer spreads from the bladder into the adjacent tissues or into distant parts of the body it is called “metastatic bladder cancer.” The most common areas affected include regional and distant lymph nodes, bone, lung, and liver. Treatment of metastatic bladder cancer usually involves systemic chemotherapy which is provided by an oncologist, or systemic cancer specialist. Occasionally, depending on the site of the metastasis, radiation may be used.

Grade and Stage Definitions

Briefly, “grade” refers to the potential that the particular tumor has to grow and spread.  Low grade tumors have cells that are relatively slowly dividing and growing.  Bladder cancer tumors of this type are often treated by removal of the visible tumor and frequent exams by a urologist to assure that there has been no change.  One common issue with low grade bladder tumors is that they often return

“Stage" assigns a number to the tumor(s) that assesses how far the cancer has spread.  The stage designations range from T0 (no evidence of a primary tumor in the bladder); Ta (non-invasive papillary carcinoma); Tis (carcinoma in situ or CIS);  T1 (tumor has spread to the lamina propria)'  T2 (tumor has spread to the muscle); T3 (tumor has spread into the tissue surrounding the bladder); to T4 (tumor has spread beyond the bladder.)

It is important for the patient to keep copies of any pathology reports (ask the urologist for them) and to take notes of discussions with the doctor.  These will be useful in the future as treatment progresses and will also bring to mind questions for the doctor.

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